THIS IS TO CERTIFY THAT THE INFORMATION REPORTED ON ALL PARTS OF THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

THIS ALSO CERTIFIES THAT THE STATE'S SHARE OF ESTIMATES IS OR WILL BE AVAILABLE TO MEET THE NONFEDERAL SHARE OF EXPENDITURES AS REQUIRED BY LAW.

SIGNATURE: STATE OFFICIAL

DATE SUBMITTED:

TYPED NAME, TITLE, AGENCY NAME, PHONE #

APPROVED OMB CONTROL NO. 0970-0163
EXPIRATION DATE: 3-31-2013

FORM ACF-696 PAGE 1 OF 1

* TARGETED FUNDS NARRATIVE REPORT ATTACHMENT: FOR LINES 1(c), 1(d), 1(e) IN COLUMN C AND COLUMN E, ATTACH A SEPARATE PAGE THAT INCLUDES A BRIEF DESCRIPTION OF THE ACTIVITIES ON WHICH TARGETED FUNDS, FROM THE FISCAL YEAR'S GRANT, WERE EXPENDED. THIS NEED ONLY BE COMPLETED WITH EACH 4TH QUARTER'S REPORT.